Soft anchor made from suture filament and suture tape

ABSTRACT

An anchor is provided for placement in or against tissue. The anchor includes a flat fibrous construct having a first end and a second end; and a filament having a first end and a second end passing through the fibrous construct in two locations including a first passing location nearest a first end of the fibrous construct, a second passing location nearest a second end of the fibrous construct, the filament remaining free to slide through the first passing location and the second passing location such that the filament can be removed from the flat fibrous construct from the first end of the fibrous construct and the second end of the fibrous construct. The anchor can be inserted into a bone hole and deployed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. Non-Provisional patentapplication Ser. No. 15/407,653 filed Jan. 17, 2017, now U.S. patentSer. No. 10/687,798 issued on Jun. 23, 2020, which is a continuation ofand claims the benefit of priority from U.S. Non-Provisional patentapplication Ser. No. 13/466,060 filed May 7, 2012, now U.S. Pat. No.9,826,971 issued on Nov. 28, 2017 which claims the benefit of priorityfrom U.S. Provisional Patent Application Ser. No. 61/518,519, entitled“Suture anchor made from suture filament and suture tape”, filed on May6, 2011. The contents of the above-identified applications areincorporated herein by reference in their respective entireties.

FIELD OF THE INVENTION

The present invention is related to a suture anchor made (i) entirely ofbraided or monofilament suture, or (ii) entirely of braided ormonofilament suture tape and suture tape.

BACKGROUND OF THE INVENTION

Anchors are commonly employed during surgical procedures to provide areliable attachment location for sutures in or against a substrate,those attached sutures then being used to capture and retain otherobjects, such as soft tissue. As such, the suture anchor plays animportant role in attaching objects, such as soft tissue to a substrate.The substrate may be bony tissue or soft tissue. In the case of bonytissue, suture anchors are generally inserted into a pre-formed hole inthe bone, so that suture extends out of the hole from the anchor. In thecase of soft tissue, suture anchors generally are placed on a side ofthe soft tissue such that suture extends through a hole in the tissue toextend beyond the soft tissue on a side opposite the anchor.

Commonly, such suture anchors contain at least one ridged member whichdeforms to create an interference fit with a substrate, the interferencefit creating a retention capacity of the anchor. Other suture anchorscontain some external feature, such as barbs or screw threads, whichinteracts with the substrate, through piercing, cutting and/or deformingthe substrate, to create a retention capacity. Other anchors includemultiple features, such as deployable barbs, to create retentioncapacity.

Soft suture anchors have also been developed, such as the BiometJuggerKnot™ (a trademark of Biomet Corporation), which utilizes a stiffbraided line, which appears to function as a barb against the side of ahole in a substrate.

Many factors have a direct effect on the actual retention capacityachieved by any suture anchor. For example, the quality of tissue, bonyor soft, may increase or decrease the retention capacity by a largedegree depending on the design of a particular suture anchor. Similarly,the quality of installation affects the retention capacity. As evidencedby the large number of suture anchors on the market, some suture anchorsperform in certain circumstances while other anchors perform better inother circumstances.

In light of the forgoing, there continues to be a need for a sutureanchor that can provide a relatively more reliable retention capacity ina variety of substrates and when installed under a variety of complexconditions.

SUMMARY OF THE INVENTION

In accordance with various embodiments of the present invention, a softanchor is described that can reliably provide an increased diameter in adeployed condition for the creation of retention capacity. Further inaccordance with various embodiments of the present invention a method ofmanufacturing is provided for the creation of such soft suture anchors.

In accordance with one embodiment of the present invention an anchor isprovided for placement in or against tissue. The anchor comprises afibrous construct and at least a first filament. Each filament passesthrough the construct in at least three passing locations comprising afirst passing location nearest a first end of said construct, a lastpassing location nearest a second end of said construct, and at leastone intermediate passing location between said first passing locationand said last passing location. In an undeployed state, each filamentextends a first length between the first passing location and the lastpassing location. In a deployed state, each filament extends a secondlength between the first passing location and said last passinglocation. The second length is shorter than said first length.

In accordance one embodiment of the present invention, the fibrousconstruct is a ribbon having a longitudinal axis extending between thefirst end and the second end, a length along said longitudinal axis, amattress thickness and a width.

In accordance with embodiments of the present invention, the passinglocations are arranged along or parallel to the longitudinal axis.

In accordance with another embodiment of the present invention, thelocations are arranged in a staggered fashion crossing said longitudinalaxis.

In accordance with embodiments of the present invention the anchorfurther comprises a second filament.

In accordance with embodiments of the present invention the firstfilament comprises a slip knot engaging said second filament near saidfirst end of said construct. Further, the second filament comprises aslip knot engaging the first filament near the second end of saidconstruct. Applying tension to a standing end of the first filament anda standing end of the second filament causes a transition from theundeployed state to the deployed state.

In accordance with embodiments of the present invention the fibrousconstruct is selected from a group consisting of a woven fabric, anunwoven fabric, a braid, and a knitted fabric.

In accordance with one embodiment of the present invention the fibrousconstruct is cylindrical having a longitudinal axis, a length along saidlongitudinal axis, and a diameter about said longitudinal axis.

In accordance with one embodiment of the present invention at least oneof said passing locations is aligned with a plane different from a planeof another of said passing locations.

In accordance with the embodiments of the present invention a pleat isformed between adjacent of the passing locations in the deployed state.

In accordance with embodiments of the present invention and in saiddeployed state, said fibrous construct is larger in at least onedirection than said fibrous construct in said undeployed state.

In accordance with the present invention a method is provided fordeploying an anchor. The method comprises providing a fibrous constructand providing at least a first filament. Each filament passes throughsaid construct in at least three passing locations comprising a firstpassing location nearest a first end of the construct, a last passinglocation nearest a second end of the construct, and at least oneintermediate passing location between the first passing location and thelast passing location. The method further comprises preparing a hole andpassing the fibrous construct into said hole. The construct is in anundeployed state where each filament extends a first length between thefirst passing location and the last passing location. The method furthercomprises tensioning each filament. After tensioning, each filamentextends a second length between the first passing location and the lastpassing location. The second length is shorter than the first lengthsuch that the fibrous construct is changed to a deployed shape.

In accordance with embodiments of the present invention the methodfurther comprises providing a second element with a slip knot capturingsaid first element near said second end of said construct. The methodfurther comprises providing the first filament with a slip knotcapturing said second filament near said first end of said construct.

In accordance with embodiments of the present invention the methodfurther comprises looping a material to be anchored through a U shapedloop formed by construct. The method further comprises passing workingends of each filament through said hole, and pulling the construct and aportion of the material through and out of the hole with said workingends. The tensioning step comprises pulling on the standing ends fromone end of said hole and said working ends from another end said hole.

In accordance with another embodiment, an anchor for placement in oragainst tissue is provided. The anchor can include, but is not limitedto, a flat fibrous construct having a first end and a second end; and afilament having a first end and a second end passing through the fibrousconstruct in two locations including a first passing location nearest afirst end of the fibrous construct, a second passing location nearest asecond end of the fibrous construct, the filament remaining free toslide through the first passing location and the second passing locationsuch that the filament can be removed from the flat fibrous constructfrom the first end of the fibrous construct and the second end of thefibrous construct.

In accordance with an embodiment, the flat fibrous construct includes alumen and is tubular.

In accordance with an embodiment, the anchor includes a deployed statein which the filament forms a semi-u-shape construct with an interiorsurface forming an interior space within a bone hole; and the first endand the second end of the flat fibrous construct is positioned withinthe interior space.

In accordance with an embodiment, the thickness of the flat fibrousconstruct is greater in the deployed state as compared to the thicknessof the flat fibrous construct in an un-deployed state.

In accordance with an embodiment, the filament having a longitudinalaxis, the flat fibrous construct including a first state in which theflat fibrous construct is uncompressed and extends along thelongitudinal axis of the filament; and a second state in which the flatfibrous construct is compressed and expanded in a directionperpendicular to longitudinal axis of the filament.

In accordance with an embodiment, the anchor further includes anintermediate location at which the filament passes through the flatfibrous construct.

In accordance with further embodiment, an anchor system is provided. Theanchor system includes, but is not limited to, an anchor including aflat fibrous construct having a first end and a second end; and afilament having a first end and a second end passing through the fibrousconstruct in two locations including a first passing location nearest afirst end of the fibrous construct, a second passing location nearest asecond end of the fibrous construct, the filament remaining free toslide through the first passing location and the second passing locationsuch that the filament can be removed from the flat fibrous constructfrom the first end of the fibrous construct and the second end of thefibrous construct; and an installation device including an end aroundwhich the filament is positioned, the flat fibrous construct also beingpositioned around the end of the installation device between the end ofthe installation device and the filament.

In accordance with an embodiment, the end of the installation devicecomprising a fork around which the filament and the flat fibrousconstruct are positioned with the flat fibrous construct beingpositioned around the fork between the fork and the filament.

In accordance with an embodiment, the first end and the second end ofthe flat fibrous construct extending along opposite sides of theinstallation device, wherein a distance from the filament positionedaround the fork to the first end of the fibrous construct is between 7.5mm to 15 mm.

In accordance with an embodiment, the first end and the second end ofthe flat fibrous construct extending along opposite sides of theinstallation device, wherein a distance from a distal end of the fork tothe first end of the fibrous construct is between 8.5 mm to 17 mm.

In accordance with an embodiment, the flat fibrous construct comprises alumen and is tubular.

In accordance with an embodiment, the anchor comprises a deployed statein which the filament forms a semi-u-shape construct with an interiorsurface forming an interior space within a bone hole; and the first endand the second end of the flat fibrous construct is positioned withinthe interior space.

In accordance with an embodiment, the thickness of the flat fibrousconstruct is greater in the deployed state as compared to the thicknessof the flat fibrous construct in an un-deployed state.

In accordance with an embodiment, the filament having a longitudinalaxis, the flat fibrous construct including a first state in which theflat fibrous construct is uncompressed and extends along thelongitudinal axis of the filament; and a second state in which the flatfibrous construct is compressed and expanded in a directionperpendicular to longitudinal axis of the filament.

In accordance with an embodiment, the anchor further includes anintermediate location at which the filament passes through the flatfibrous construct.

In accordance with an embodiment, a method of anchoring tissue to boneis provided. The method includes the steps of providing an anchorincluding a flat fibrous construct having a first end and a second end;and a filament having a first end and a second end passing through thefibrous construct in two locations including a first passing locationnearest a first end of the fibrous construct, a second passing locationnearest a second end of the fibrous construct, the filament remainingfree to slide through the first passing location and the second passinglocation such that the filament can be removed from the flat fibrousconstruct from the first end of the fibrous construct and the second endof the fibrous construct; inserting the anchor into a hole in a bone;and deploying the anchor into the hole.

In accordance with an embodiment, the flat fibrous construct comprises alumen and is tubular.

In accordance with an embodiment, the anchor includes a deployed statein which the filament forms a semi-u-shape construct with an interiorsurface forming an interior space within a bone hole; and the first endand the second end of the flat fibrous construct is positioned withinthe interior space.

In accordance with an embodiment, the thickness of the flat fibrousconstruct is greater in the deployed state as compared to the thicknessof the flat fibrous construct in an un-deployed state.

In accordance with an embodiment, the filament having a longitudinalaxis, the flat fibrous construct including a first state in which theflat fibrous construct is uncompressed and extends along thelongitudinal axis of the filament; and a second state in which the flatfibrous construct is compressed and expanded in a directionperpendicular to longitudinal axis of the filament.

BRIEF DESCRIPTION OF THE DRAWINGS

So that the manner in which the above recited features of the presentinvention can be understood in detail, a more particular description ofthe invention briefly summarized above may be had by reference to thefigures, some of which are illustrated and described in the accompanyingappendix. It is to be noted, however, that the appended figuresillustrate only typical embodiments of this invention and are thereforenot to be considered limiting of its scope, for the invention may admitto other equally effective embodiments. Moreover, the drawings are notnecessarily to scale, with emphasis generally being placed uponillustrating the principles of certain embodiments of invention.

Thus, for further understanding of the nature and objects of theinvention, references can be made to the following detailed description,read in connection with the specification following below in which:

FIG. 1 represents a fibrous construct for use with various embodimentsof the present invention;

FIG. 2 represents a first embodiment of the present invention;

FIG. 3 represents a typical environment for deployment of variousembodiments of the present invention;

FIG. 4 represents an embodiment of the present invention and aninstallation device in accordance with the present invention;

FIG. 5 represents the embodiment of FIG. 4 in the typical environment ofFIG. 3 with the anchor in an undeployed state in accordance with thepresent invention;

FIG. 6 represents the embodiment of FIG. 4, in a deployed state inaccordance with the present invention;

FIG. 7 represents a variation of the embodiment of FIGS. 2 and 4;

FIG. 8 represents a variation of the embodiment of FIGS. 2 and 4;

FIG. 9 represents a variation of the embodiment of FIG. 2;

FIG. 10 represents a second embodiment of the present invention;

FIG. 11 represents a deployed state of the embodiment of FIG. 10;

FIG. 12 represents a variation of the embodiment of FIG. 10;

FIG. 13 represents the anchor of FIG. 12 at an initial step ofinstallation in accordance with the present invention;

FIG. 14 represents an installation step subsequent to the step of FIG.13; and

FIG. 15 represents an installation step subsequent to the step of FIG.14.

DETAILED DESCRIPTION OF THE INVENTION

With reference to FIGS. 1-15, there is provided a soft anchor,variations and embodiments of which are configured so that in a deployedstate, the soft anchor enlarges to a predictable, enlarged diameter.This enlarged diameter may be used to laterally displace cancelloustissue forming the sides of a preformed bone hole and to engage theharder cortical layer of the bony tissue. This enlarged diameter mayalso be used to engage an outer surface of a bony or soft tissue toprevent passage of the enlarged diameter through an adjacent hole inthat bony or soft tissue.

Before discussing specific embodiments, it may be helpful to understandthat each of the soft anchors discussed herein contain two sections: atleast one filament, which is a suture to be anchored; and a fibrousconstruct, which is to form a portion of the anchor that increases indiameter as part of deployment. Even though it is the fibrous constructthat increases in diameter at deployment, it should be understood thatthe filament also plays a role in the anchor even though the filamentmay remain free (in some embodiments) to slide in relation to thefibrous construct. The filament helps to position, align and support thefibrous construct, such that if the filament were to be removed from thefibrous construct after deployment of the anchor, the fibrous constructmay be free to spill (i.e., release), allowing the fibrous construct tocollapse and shrink in size, allowing for easy removal.

In other words, the fibrous construct has two primary functions. First,it becomes a base for the filament to slide within. Second, whencompressed and/or pleated during deployment, the fibrous constructbecomes more compact in one direction thereby expanding outwardly andincreasing its overall diameter to create a retention capacity. Thisaction of having the fibrous construct change in shape to increase itsoverall diameter is a useful characteristic which may be usedadvantageously to secure the anchor in a hole or against a bony or softtissue. It is this combination of the expanding fibrous constructcoupled with the filament remaining slidable (in some embodiments) inrelation to the fibrous construct that render the present inventionideal for the reattachment of soft tissue to bone or soft tissue to softtissue where it is desirable to pass sliding knots to secure a repair.

The term ‘standing end” is used throughout the following to refer to oneor both of the ends of a filament that will ultimately be placed underload by a surgeon during surgery. In relation to at least oneembodiment, the term “working end” is used to describe an end of afilament used to create a knot. This is the end that would be pulled totighten the knot while pulling the standing end may cause to the knot toslide, as in the case of the slip knot described herein.

Filament, as the term is used and described herein, includes braided(i.e., multi-filament) suture and monofilament suture as well as anyother metallic or non-metallic filamentary or wire-like materialsuitable for performing the function of a suture. This material caninclude both absorbable and non-absorbable materials.

FIGS. 1-6 disclose a first embodiment and a method of deploying thefirst embodiment.

FIG. 1 shows a fibrous construct 20, which may more commonly be referredto as a suture tape. The fibrous construct 20 has a first end 20, 21 anda second end 20, 22 along with a mattress thickness 23, a width 38 and alength 39 along a longitudinal axis 24. Note that a more specificdescription of the construction and material of the fibrous construct 20will follow after the remaining portions of the anchor 1 are described.

Referring now to FIG. 2, the anchor 1 includes a filament 30, which ispassed through the fibrous construct 20 at passing locations 25. To helpexplain the function of the anchor 1, it may be helpful to define afirst passing location 25, 26, which is a passing location 25 nearestthe first end 21 of the fibrous construct 20. Similarly, a last passinglocation 25, 27, is a passing location 25 nearest the second end 22 ofthe fibrous construct 20. Each passing location 25 is a location wherethe filament 30 passes through the mattress thickness 23 of the fibrousconstruct 20. In the present instance shown in FIG. 2, there are sixpassing locations 25. For reasons that will become more evident, as fewas three passing locations 25 on a particular anchor 1 may functionwell. Similarly, more passing locations 25 may be provided, but thereappears to be a reasonable limit where more passing locations provide nobenefit or where additional passing locations actually hurt performance.It has been discovered that each additional passing location increasesfriction against the filament 30 thus reducing a surgeon's ability toslide the filament 30 in relation to the fibrous construct 20.Therefore, with any material change of the fibrous construct 20, someexperimentation is expected to balance ability for the anchor toincrease in size upon deployment against ability for the filament 30 toslide in relation to the fibrous construct 20. Lastly on this point,there may be even or odd numbers of passing locations 25.

All of the passing locations 25 in the anchor 1 of FIG. 2 occur alongthe longitudinal axis 24. Instead, the passing locations 25 may beoffset a distance from the longitudinal axis 24 such that they arearranged parallel to the longitudinal axis 24. Similarly, the passinglocations may be staggered such that one passing location is on one sideof the longitudinal axis 24 while an adjacent passing location 25 is onan opposite side of the longitudinal axis 24.

A first distance 31 between the first passing location 25, 26 and thelast passing location 25, 27 is an important aspect of FIG. 2 eventhough its importance will not become evident until the discussionrelating to FIG. 6. This first distance 31 is measured in the undeployedor uninstalled state as it is reduced to a second distance 32 (FIG. 6)in the deployed state.

Lastly in relation to FIGS. 1 and 2, a fibrous construct 20 inaccordance with the present invention may have a ribbon length of 15-30mm with a preferred length of 25 mm. The width 38 of the fibrousconstruct 20 may be 2-4 mm with a preferred width of 3 mm. The mattressthickness 23 was found to vary greatly (due to relative tension orcompression) and all were found to work well. Additional passinglocations 25 can be added when using a fibrous construct 20 having arelatively thin mattress thickness 23, and vice versa.

FIG. 3 is merely a representation of a hole 10 prepared in bone for theanchor 1 to be deployed. In this view, the hole 10 extends along an axis14 through a cortical layer 12 and into relatively softer cancellousbone 11. This hole 10 may be made using any of the known techniques,such as a drill or punch. It should be understood that the anchor 1 isdesigned for a particular diameter through the selection of a particularmattress thickness 23, and number of passing locations 25.

Referring now to FIG. 4, the anchor 1 is assembled onto an installationdevice 40 having a forked end 41. The anchor 1 is arranged on theinstallation device 40 such that half of the fibrous construct 20extends along one side of the installation device 40 while the otherhalf extends along a far side of the installation device 40. In eachinstance, the filament 30 and the fibrous construct 20 are passedthrough the fork 41. Note that the fibrous construct 20 of FIG. 4 isslightly different variation of the fibrous construct 20 of FIG. 2 inthat there are only four passing locations 25, two passing locations 25visible and two passing locations 25 on the far side.

It has been found that a distance 44 from the filament to an end of thefibrous construct 20 may be from 7.5-15 mm, with 12 mm workingespecially well. It has also been found that a distance 43 from thedistal end of the installation device 40 to an end of the fibrousconstruct 20 may be from 8.5-17 mm with 15 mm working especially well.

As may be seen on FIG. 4, a distal end portion of the installationdevice 40 may have a reduced diameter. It has been found that thesmallest possible diameter, with strength being a limiting factor, ispreferred because the anchor 1 is required to expand an amount toaccount for the installation device 40 in addition to an amountnecessary to displace cancellous bone 11.

Referring now to FIG. 5, the installation device 40 and the anchor 1 areinserted into the hole 10. Note that the relative fit of the anchor 1 inthe hole 10 is shown as overly “loose” for the purpose of provided aclear view for the preset description. Ordinarily, the filament 10,fibrous construct 20, and installation device 40 would be tightlypressed into the hole 10, as any excess space would need to be taken upby the expansion of the anchor 1.

As shown in FIG. 5, the filament 30 and the fibrous construct 20 areinstalled in an elongated fashion along them to pass take on a smallestdiameter configuration, referred to herein as a undeployed state orinstallation state. Again, the depiction in FIG. 5 is loose for the sakeof clarity.

Looking now to FIG. 6, deployment occurs as the installation device 40is removed and the filament 30 is tensioned causing the fibrousconstruct 20 to grip the wall of the cancellous bone 11 and expand intoa deployed state, also referred to herein as the second state. As withFIG. 5, this view is shown loose for clarity in that the filament 30would likely be much closer to one another.

More importantly, FIG. 6 depicts how the fibrous construct 20 is foldedto form pleats 29 between adjacent passing locations 25. This pleatingreduces the distance between the first passing location 25, 26 and thesecond passing location 25, 27, as measured along the filament 30, fromthe first distance 31 (FIG. 2) to the second distance 32, which isrelatively shorter than the first distance 31. These pleats 29 form astack of the mattress thicknesses 23 (FIG. 1) effectively increasing adiameter (as measure in relation to the axis 14 of the hole 10, causingthe anchor 1 to displace cancellous bone 11. This relative increase insize in distance from the axis 14 of the hole 10 creates a retentionforce of the anchor 1.

As can be understood from FIG. 6, increasing the number of passinglocations 25 from the four shown to five, six, seven or more is likelyto increase the size of the anchor 1 after deployment and the number ofpleats 29 is therefore increased. As mentioned above, a limiting factoris an amount of friction increased by additional passing location 25. Itshould be understood that a reducing the number of passing locations 25to three may also function well in certain instances.

In light of the forgoing, it may now be understood that a large varietyof contractions and materials will work for the fibrous construct 20. Ithas been discovered that for each type of construction (i.e. braided,woven, non-woven, or knitted) there is an advantage for using a materialthat increases in width 38 for every reduction in length 39. Thisadvantage provided for increased diameters for a particular number ofpleats 29. On other words, this Poison's ratio of width and/or mattressthickness growth during a reduction in length provides for an increasein deployment size that is additive to the increase due to the pleats.

Further, certain constructions may be found to possess an initial statethat is longer on length along the longitudinal access and thus thinnerin mattress thickness and width. Such an initial state may help toreduce a diameter of a particular anchor's initial or first state whilecontinuing to result in a large (relatively) deployed or second state.

The material itself may ultra-high molecular weight (UHMW) polyethylene,polyester, or many of the other known implantable materials. Moreimportantly, the material must be able to deform into the shapesdiscussed further below while remaining capable of retaining a suturefrom tearing through. In other words, it is acceptable to use a materialof lesser strength.

FIGS. 7 and 8 show variations of the first embodiment, each of thesevariations having two filaments 30, 35. In the variation of FIG. 7, thefirst filament 30 and the second filament 35 have a similar number ofand arrangement of passing locations 25. The variation of FIG. 8includes a similar arrangement where the filament 25 is passingoppositely through a similar number and arrangement of passing locations25.

With the addition of the second filament 35, it is contemplated that thenumber of filaments may become confusing, especially in the confinesexperienced during surgery. This issue is of special concern in light ofthese anchors 1 because of the additional suture material present.Accordingly, it is envisioned that there be some form of color change atleast between the first filament 30 and the second filament 35. Further,it is envisaged to identify each of the free ends of the filaments 30,35 with different colors. This could be accomplished by having setlengths of particular colors or dying the free ends of the filaments 30,35.

FIG. 9 shows a variation of the first embodiment that is similar is formand function to the anchor 1 of FIGS. 1-6 except the fibrous construct20 is cylindrical as opposed to a flat tape. Again, this embodiment issimilar to the anchor 1 of FIGS. 1-6 in that it is installed in anundeployed state and forms pleats when a distance between the firstpassing location 25, 26 and the second passing location 25, 27 isreduced during deployment. Note that because of the cylindrical natureof the fibrous construct 20, the filament 30 may be beneficially passedthrough the fibrous construct 20 in different plane. As shown in FIG. 9,at the first passing location 25, 26 and the last passing location 25,27, the pane is parallel to the drawing sheet. At each of the twointermediate passing locations 25, 28, the filament 30 is passed throughthe fibrous construct 20 in a plane perpendicular to the sheet of thepage. Accordingly, pleats will still be formed between each of thepassing locations 25, but they will likely be formed at differingangles, thus creating expansion in differing directions (but still awayfrom the axis 14 of the hole 10).

Referring now to FIGS. 11-15, a second embodiment is shown. Note that isembodiment is quite similar to the variations of FIGS. 7 and 8 whilealso remaining quite similar to other variations of the firstembodiment. Accordingly, all of the reference numbers remain similar.

The embodiment of FIGS. 11-15 further includes slip knots 42 in each ofthe filaments 30, 35. In particular, a first slip knot 30, 42 in thefirst filament 30 is formed near the second end 22 of the fibrousconstruct 20. This first slip knot 30, 42 captures the second filament35. A second slip knot 35, 42 is formed in the second filament 25 nearthe first end 21 of the fibrous construct 20. This second slip knot 35,42 captures the first filament 30. Otherwise, the construction of theanchor 100 of this embodiment is similar to the earlier embodiments andvariations.

As shown in FIG. 11, the addition of the first slip knot 30, 42 and thesecond slip knot 35, 42 allow for deployment of the fibrous construct 20and the overall anchor 100 into a deployed state without being confinedin a hole. Rather, by pulling the a standing end 33 of the firstfilament 30 and a standing end 36 of the second filament 35, the knots42 force the fibrous construct 20 into the deployed state such that isbecomes too large to pull back through any hole from which it wasoriginally passed. Once deployed, the standing ends 33, 36, a workingend 34 of the first filament 30 and a working end 37 of the secondfilament 35 may be tensioned. Note that by tensioning the working ends34, 37, each of the knots 42 will be tightened, helping to lock thefilaments 30, 35 in relation to the fibrous construct 20.

FIG. 12 depicts a variation on the embodiment of FIGS. 10 and 11. Asshown in FIG. 12, each of the standing ends 33, 36 are passed backthough at least one loop (two shown in FIG. 12) formed between thefilaments 30, 35 and the fibrous construct 20 between adjacent passinglocations 25. This passing of the standing ends back through the loopshelps to redirect, in an orderly fashion the direction of the standingends 30, 35 such that they pass out of one end of a through hole whilethe working ends 34, 37 are directed to pass out of an opposite end ofthe through hole, an implementation of this anchor 100 beingdemonstrated in FIGS. 13-15.

As shown in FIG. 13, the anchor 100 is positioned at one end of a hole10 such that the fibrous construct 20 is pulled into a “U” shape. Theworking ends 34, 37 pass entirely through the hole 10 to extend therefrom while the standing ends 33, 36 remain exposed at the opposite end.

In FIG. 14, a portion of connective tissue 50 (or other fibrous tissue)is passed through the “U” shaped fibrous construct 20 in the anchor 100in preparation to be pulled through the hole 10.

In FIG. 15, the connective tissue 50 is drawn through the hole 10 bypulling on the working ends 34, 37 of the filaments 30, 35. Once thefibrous construct 20 is beyond the hole 10, the standing ends 33, 36 maybe tensioned, causing the fibrous construct 20 to deploy into its secondstate in a manner similar to that of FIG. 11. Afterward the working ends34, 37 and/or the standing ends 33, 36 may be tied, securing theconnective tissue to the anchor 100 and the anchor 100 in its deployed,second state.

As with the previous embodiment, it may be helpful to color theindividual ends of the filaments for differentiation during the surgicalprocedure.

All the embodiments and processes described above may be altered withinthe scope of the present invention to accommodate different size andstrength requirements based on the variables provided above.

What is claimed is:
 1. A method of anchoring tissue to bone, comprisingthe steps of: providing an anchor including: a flat fibrous constructhaving a first end and a second end; and a filament having a first endand a second end passing through the fibrous construct in two locationsincluding a first passing location nearest a first end of the fibrousconstruct, a second passing location nearest a second end of the fibrousconstruct, the filament remaining free to slide through the firstpassing location and the second passing location such that the filamentcan be removed from the flat fibrous construct from the first end of thefibrous construct and the second end of the fibrous construct; insertingthe anchor into a hole in a bone; and deploying the anchor into thehole.
 2. The method of claim 1, wherein the flat fibrous constructcomprises a lumen and is tubular.
 3. The method of claim 1, wherein theanchor comprises a deployed state in which: the filament forms asemi-u-shape construct with an interior surface forming an interiorspace within a bone hole; and the first end and the second end of theflat fibrous construct is positioned within the interior space.
 4. Themethod of claim 3, wherein the thickness of the flat fibrous constructis greater in the deployed state as compared to the thickness of theflat fibrous construct in an un-deployed state.
 5. The method of claim1, the filament having a longitudinal axis, the flat fibrous constructcomprising: a first state in which the flat fibrous construct isuncompressed and extends along the longitudinal axis of the filament;and a second state in which the flat fibrous construct is compressed andexpanded in a direction perpendicular to longitudinal axis of thefilament.